HHS found that 19 percent of nurse aides who'd been disciplined had a prior conviction that would have shown up on a background check.

Matt RourkeAP

There are two ways to look at results of a recent investigation of nursing homes by the U.S. Department of Health and Human Services. Both are pretty disturbing.

The investigation, conducted by the HHS Office of Inspector General, looked at the cases of 1,611 nurse aides who were disciplined for abuse, neglect and theft at nursing homes in 2010. All told, 19 percent of the aides had prior criminal convictions that would have popped up on a background check.

On the one hand, it's troubling that a simple background check could have flagged aides with records that raised questions about their suitability for work taking care of vulnerable elderly people.

On the other hand, it seems just as troubling that background checks wouldn't have given any clue about the other 81 percent of the disciplined nursing aides.

Nursing professor Charlene Harrington at the University of California, San Francisco, said she's most disturbed by the fact that nursing homes had hired some aides who'd been convicted of serious crimes such as assault, battery and rape. "The first line of defense is to not put someone on the job who's been convicted of some awful crime," she said.

The inspector general found that the majority of disciplined nurse aides with prior records had been convicted of burglary, larceny or other crimes against property. Only a tiny fraction had convictions for crimes against people. However, the investigation also found that, before their respective nursing homes disciplined them, three nurse aides had registered as sex offenders.

Harrington says nurse aides, not to be confused with registered nurses, often operate with little supervision, are paid minimum wage and receive only a few weeks training.

"They seem replaceable," she said. "Most nursing homes are poorly staffed. They don't have enough registered nurses. Many of them only have one RN who's the director of nursing and they're only on the day shift."

The Inspector General's report - which can be read here - was mandated by the federal health reform law. One of the law's provisions gave grants to states to support nursing homes background checks of employees. This report is an evaluation of those grants.